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ou naTo11orujaTa H cepH03HOCTa Ha rrp06JIeMoT AKo 6011ecTa e BO nOltIeTHa ltpa3a

MO)Ke )la ce TpeTHpa co 11acep HJIH CKJ1epOTep amlja lloueKa BO nOOUMl1HaTa ltp83a

BeH l1Te MO)l(aT lIa 611UaT oTCTpaHeTl1 npeKy CI1THH 3aCeLlH n03HaTlI KaKO

MI1KpoBacKYJ1apHFI (rrp060JBu ) TeXHUKI1 AKo cacenteHCKaTa BeHa He ltPYRIltJ(HOHl1pa

npaBI1J1HO 06WfflO ce TpeTHpa co Te HUKa HapeIfeHa paUl1o-ltppeKltppeHUI1CKa

a6J1aUl1ja

bull AHrHonl1acTHKa ua AOJ1HHTe eKcTpeMHTeTH - OBaa HliT pBeHIU1ja ce npaBH co ueJI

)la ce nO)l06pM cHa6llYBaEb 0 co KpB Ha llOJlHMTe eKCTpeMl1TeTH M [la ce crrpe4aT

I1CXeMI14HH npoMeHH Ha HCTlITe Pe3YJ1TaTHTe Oll 6aJJ H aH 110nJ1aCTI1KaTa 3aBHcaT Oll

J10Kall1jaTa 11 npOleHTOT Ha CTeA03aTa AHfHOnnaCTI1KaTa Ha H11Hja-lHI1Te aJITepHI1

I1Ma pe4lfCH HGT ycnex KaKO XHpyprHjaTa eKapHTe O[l BaCKYJ1a~HaTa X11pyprHJa pacnOJlaraaT co arnpoK cn eIltTap Ha MmUlMaJlHO I1JiBa3HBHl1 TeXHHKH

bull KopoHapHo CTeHTllpalhe - KopoHapHOTo CTeHTHpaJ-he H 6anOH llMJ1aTauuj aTa Ha

KopoHapHlfTe KpBHH Ca[lOBM npe TI3BHlltaa peBo11Y[(li]a BO TpeTMaHOT Ha KopoHapHaTa

apTepl1CKa 60J1ecT Igtp3a a peBa KynapH3aUlIja nOCJle HaCTaHYBaJ-be Ha aKYTeH MHOKap)leH IIHltpapKT aM fO npo~onJKH )KHBOTOT Ha orpOMeH 6poj nauaeHTH H

OB03MQ)KI1 HaMaJlYBaJ-be Ha HH1lHll ~aTa Ha HCXeMFflHaTa KapuMOMHOnaTHja

bull KapOTllllHO CTeHTllpalbe - KapOTH)lHOTO CTeATlfpal-b e p e11aTl1BHO HOBa HHTepBeHuHja Koj a MO)f( n a 6Hue eUHaKBO )l06pa KaKO H m pypillKaTa oc06eHo Kaj

BHCOKOP H4HH llauneHTII co nYJTMOHaJIHa oJIeGT Kopo HapHa 6oJ1eCT 11 6y6p )KHa I1Hcy cpnUHeHUl1ja H OBaTa T XHOJIornja CTaHYBa ce no6p3o nOCTaITHa co IllTO

CHrHlIltpI1KaHTHO ce aMaJlYBa PI-l3HKOT on rrep KYTaHHTe npo ueuypl1 CaMO cneUI1JaJ1I1CT co r011eMO 11CKyCTBO MO)f(e a O)lnyqn llaJJM ITauHeHTOT e 3a CTeHHlpaJ-he

HJllI a XUpyp LU a I1HTepBeHUIIJa

bull PeHaJ1Ha apTepnCKa aHrHOnJ1aCTHKa - I1HcYltPHIJHeHTHaTa 11l1pKYJIauHja Ha 6y6pe3lne Haj 4ecTo e p y11TaT Ha aTepOCKJIep03a l1J1lf KarruI1CIHf1(alllija Ha

peHMHHTe apTepIUI 11 Heper YJI11paHa XlmeJITeH3Hja Hajll06ap MeTOlJ 3a

LIl1jafHOCTl11lHpaJ-he e aHntorpacentHja n )lOKOJ1KY I1Ma CI1ltpHl-f(Pl1KaHTHH CTeH03H Haj~06pa ltpopMa Ha TpeTMaH e peHaJIHa apTepCKa aHrHOrrJlaCTMKa K aKO WTO e

cnOMeHaTO H norope p ynTaUITe OLI aHTMOnnaCTHKaTa ce peIfHCJI Uo6p l1 KaKO 11

npypwKHOT TpeTMaH HO ce AMeK) nOMM1le I1HB83HBHI1

bull OnCTpYKJIHja Ha V cav a inferior - Bo06 l1 -1aeH TpeTMaH rrp l1 3rp)TYYBaJ-he Ha KpBTa BO )l11a60KJITe Bemi Ha H03eTe e aHTHKoaryJI8ll1ja DBa 3HaQHTeJIHO ro HaMaJ1yBa

PM3HKOT Oll eM60mI3alJHja BO 6eJ1 l1Te [lP060BM Ho HeK 11 rrauMeHTIJ He MO)KaT lIa

6HLIaT nOCTaBeHI1 Ha aHTHKoary11aHTHaTa Tepanl1ja nopauI1 pH3I1K Oll KpBapelhe B o

OBl1e clnyaul1l1 npeK) MaIm UHUH3Jfl1 BO npenOHlfTe ce nnacnpa tpHJI epuo rOJ1eMHTe

13 3

BeHH BO a6ll0MeHOT V cava co peHTIeH 3pauH KaKO BOn111 Bo OBHe

nOMUHYBa KpBTa OLI llBeTe H03a )lOKOJIKY e nOYpe6HO OBHe CPHJITPH MmKar H3BalleHM noa nOKaJJHa aHeCTe311a HCTO TaKa co MHOry MaJJa HHUII3HJa

bull MHHJIMaJlHO nHB33HBtlHT e B3CKYJl 3PHH T e XHUKII - ce KOpl-1CTaT 1-1 npL-1 TpeTMaH Ha

BpOAeHI-1 CpleBL-1 3a6onYBal-ba Kaj Aela VI B03paCHL-1 CO WTO ce 1-136erHysa BL-1COKI-10T pL-1311K

WTO ro HOCI-1 XI-1 PypWKI-10T 3acPaT Ha OTSOpeHO cpue Co nepKYTaHI-1 I-1HTpasacKynapHI1

np0leAypL-1 MOgtfltHO e pewasal-be Ha ASD 1-1 VSD AecPeKTIi1 CO nOCTaBYBal-be Ha cnelL-1janeH

anplacer KOj ro

3mneopmbe HO Aelfco o-JlyiJep

OKJIYLUipaaT HHTpaaTPHJaJlHIIOr OlHOCHO HHTPaSeHTpl1KynapHu or npOCTOp

3aTBapatbe Ha DAP (ductus arteriosus persistens) co KOpHCretbe Ha rope

crrOMeHaTaTa TeXHliKa MO)J(HO e peruaBalbe H1lII y 6na)(YBalbe Ha CHMnrOMl1re Kaj

nyn MoHarJHa CTeH03a aopTHa CTeH03a H KOapKT3Ul1Ja Ha aOpTaTa co nOMOW Ha

6anoH UliJlaTaUl1ja Co COOlBeTeH llliTPaBacKYJIapeH 6anoH ce npHCTanysa no

MeCTOTOT Ha CTeH03aTa ce HRcpl1JITpHpa B03~X BO 6anoHor co OllpelleH npl1TlICOK

no rrperxOlIHO mmpaBeHH npeCMeTKlf cnpeMa llHMeH3mrre Ha creHOTHLfHHOr neJ]

OBHe npoueuypH KOH f H H3BellYBaMe II BO HawaTa YCTaHoBa Kaj HOBOpOlleHIl I

MJlan1I lleua llaBaaT OnJllPllilf pe3ynTaTlI H liM OB03Mm(YBaaT DOHaTaMOWeH

HopMaJJeH paCT H Pa3BHTOK co MHHl-IMaJIeH HHBa3HEeH npllcTan Ce IOBellysaar BO

HHTpaBeHCKa aHaJIrO CelIaurija Koja IrMa 3a uen MHpHO H KoonepanlBHO llere Koe

lOnOJIHliTeJTHO ce 06e360JIYBa co JIOKaneH arieCTeTHK Ha BJle3HOTO Mecro lIa

KaTeTepOT TIawleHTlITe OCTaHyBaaT enHa HOK BO 60IDmua 3a CJIellelbe Ha BlITaJJHHTe

CPYHKUHII

134

bull ltlgtHfiepOnTHIKa MeJeHTepHj aJlHa nyJlC OKCHMeTpHj a - ce KOp~ CT~ 3a AllljarH03a Ha

XpOHIIILfHa Me3eHTepllljallHa IIIcxeMlllj a Ce 1013BeAYBa TaKaWTO ltp1II6epOnTVlLf KVI KaTeTep KOj WTO Ha BPBOT VlMa nyll c OKCIIIMeTap ce nnacpa Io1HTPaBaCKYllapHO BO a mesenterica

nYIlCOKCVlMeTapOT np lll KOHTaKTOT co MYK03aTa Ha LpeBaTa ja MepVl pen10HallHaTa

CaTYpaLlo1ja co KVlCIlOPOA Koja -HOpManHO BO LpeBH aTa MYK03a 1113HecYBa 60-70 Kaj XpoHVlLfHa Me3eHTepVljallHa VlcxeMVlja caTypaLVlj aTa Vl 3HeCYBa 16-30

bull Pa~lIoctgtpeKctgtpeHTHa afiJlaQHja - BO KapAVlOJlOrVljaTa ce KOPVl CTIII 3a TpeTMaH Ha aTpVljaJleH ltpJlaTep aTpVljaJlHa ltpVl6pVlllaLVl ja cynpaBeHTpVlKyJlapHa Tax~KapA~ja VI HeKOIII

nmOBVI Ha BeHTpVlKyllapH~ ap~TMVlVI Ha BPBOT oA KaTeTepOT e nOCTaBeHa eJleKTpOAa npeKY Koja ce eMIIITYBa paAVloltppeKqpeHTHa eHeprlifja liflllt1 KpVl oa6naLlII ja npll1CTanOT e npeKy

ltpeMopallHaTa BeHa AeCHaTa npeAKoMopa Vl HTpaaTpllljallHVloT cemyM neBaTa npeTKoMopa

AO cVlHoaTpllljallHllloT LfBOp OBaa MeToAa e MOAepHa 3aM eHa 3a XVl PYPWKO peWaBat-be Ha

oBoj np06lleM

Clue OBlie HaBeJ]eHlI ce nOBeKe HaoraaT M CTO BO Mo[epHaTa M [UUHHa noneKa IICTlfcHYBajKi-I m KJlaClf4HHTe XUPYPWKH npoue[ypu

35

Ha 6pOjOT

HHTJIMan

aopTHI

BO paMKHTe

HCTO

KJIacllqmu

nplIcpaTeH

AHECTE3HJA 3A X 1IPypr UJA HA AOPTA

Talba MaHaHJIOBa

IiOJIeCTHTe Ha TopaxaJIHaTa aopTa Haj1eCTO ce XI1PYPWKH npOOJIeMI1 H 6apaaT XHpyplllKH TPeTMaH XHpypillKHOT TPeTMaH Ha TopaxaJlHaTIl aopTa MO)(e ua 6H))e

bull HTeH (AxYTHa H cy6aKyTHa aopTHa LlllceKUlfj a pymypHpaHa aopTHa

TpaYMaTCKl1 nOBpeLlll Ha aopTaTa)

bull E JTeKTHBeH (CTa6HJrnaTa TOpaKaJIHa 11J1H TopaKoa6))OMHHaJ1Ha aopTHa aHeBpH3Ma

KOapKTaUl1j a IUlII 3TepOMaTo3Ha 60J1eCT WTO npeJUl3B I1K)Ba eM60muaUHja)

3 r 0J1eMeHaTa j aBHa CBecT 3a 60 J1eCTTlTe Ha TopaKam iaTa aopTa paHO npen03HaBalbe Ha CM

3a aKyrHaTa aopTHa 60JIecr OLl cTPaHa Ha IHHaTa MezU1UHHCKa nOMOW no))o6peHa TeXH0J10rnja

BM3yanH3aIJ11ja 11 CTapeeJbeTO Ha HaceJleHlleTO npHLOHeCYBaaT 3a 3r0J1eMYBaJbe

rraUHeHTIfTe KOI1 HMaaT DOTJJe6a OLl aopTHa XJi pypruja

AHeCTe311jaTa Kaj nau~ieHTH WTO HMaaT nOTpe6a 00 aopTHa xl1Pyprl1ja e npe)JH3BliK llpouecOT

peKOHCTpYKUMja HJUI 3aMeHa Ha lJen OJ] TOpaKaJIHaTa aopTa ODH1HO 6apa npuBpeMeH npeKlfH

npoToKoT Ha KpB np11 TOa co3LlaBajKH n OTeHUujaJI 3a HcxeMuja HJ1H HHltpaPKT

I10CTanKHTe 113Bpw eHH OJ] CTpaHa Ha XHpyp3HTe H aHeCTe3HOn03HTe 3a 3aWTIn a Ha OpraHlITe

onepauIDf Ha TOpaKaJlHaTa aopTa ce

bull deep hypothel111ia circulatory arrest

bull CeJIeKTliBHa aHTerpamta JlJlli perporpauHauepe6paJ1Ha nePltPY3Hja

bull ))peH8)I(a Ha JIYM6aJIHaTa llepe6pocmIHaJlHa TeLjHOCT

KaKO eLlHa OLl HajypreHTHlITe COcroj6H Kaj TOpaKaJIHliTe 60JIeen Ha aopTaTa

lUfCeKUl1ja nplPUfHa 3a HaCTaH)Bafbe Ha aopTi-ra llflCeKIUfj a e paCKJIHYBalbe Ha

aOpTaTa H3J10)i(BajKH ro cpe))HHoT CJIoj Ha rryJICI-lpa1 KHOT npIITHCOK 0)) KpBTa BO

J1YMeH KpBTa IDTO H3JIeryBa Oll MeCTOTO Ha pacuenYBalbe n penH3BHKYBa CJlOeBHTe Ha aopTaTa

ce OllJIenaT H Aa ce llOpacllenyaa HHTIfMaTa HanOJ1)HO HJ1l1 UHPKYMltpepeHTHo

aopraTa c03QaBajKH BHCTHHCKH 11 na)f(eH JIYMeH C03llaneHH OA alJBeHH IUHjaTa ~eCTo

AHceKUHja ce npowupyBa LlHCTaJTHO OJ] MeCTOTO Ha pacuen no ))OJDKHHaTa Ha aopTaTa HO

TaKa MO)J(e lla ce npoIDHpyBa npOKCHMaJIHO HJlH BO peTporpalleH npaBeu KaKO UJTO ))HceKUllj

ce n pow wpYBa no ))OJDKHHaTa Ha Ca)lOT MO)l(e lla rH 3altpaTI1 aOpTmlTe rpaHKH WTO pe3yJITHpa co

CHHLPOMH Ha HaMaJ1eHa nep $Y3Mja TIpoillHpYBa HeTO Ha llHceKuHj ara BO aopTH HOT KopeH M01Ke 1l1

n peAI13BHKa aopTHa perypmTal(1 lj a TOp aKaJTHa aopTHa llHCeKUI~ia MO)(e lla ce

cnopeA JIOKaul1jaTa H CTeneHOT Ha aopTHa ))11ceKUHja nOCTojaT llBa on on o

KJIaCHltjJHKallHOIDI meMH 3a ToparltaJllia aopTHa ))HceKUHja

KnaCHltpHKaUllja Ha aKYTHa aopTHa QHceKUHja

DeBaleJ K JlaCJ1(j1I1Ka w-~a Tnn J BKJIyqyBCUbe Ha ueJlaTIl aopTa (Aorta ascendens arcus H Aorta descendens)

Tnn D OrpaHH1em1 Ha aClleHleHTHa aopTa

THn Ill MeCToTo Ha pacuenyBalbe e Oll necueHUeHTHara aopra co llVlCTal1HO MJIM peTPorpaDHo

npowyaalbe

Stllnf ord KJIaCHCpl1KauHja

T Hn A BKJIyqYBafbe Ha aCueHlleHTHaTa aopTa 11M JIaKOT Ha aOPTaTa 6e3 orJIeo Ha MeCTOTO Ha

nOTeKllO

136

bull ltlgtHfiepOnTHIKa MeJeHTepHj aJlHa nyJlC OKCHMeTpHj a - ce KOp~ CT~ 3a AllljarH03a Ha

XpOHIIILfHa Me3eHTepllljallHa IIIcxeMlllj a Ce 1013BeAYBa TaKaWTO ltp1II6epOnTVlLf KVI KaTeTep KOj WTO Ha BPBOT VlMa nyll c OKCIIIMeTap ce nnacpa Io1HTPaBaCKYllapHO BO a mesenterica

nYIlCOKCVlMeTapOT np lll KOHTaKTOT co MYK03aTa Ha LpeBaTa ja MepVl pen10HallHaTa

CaTYpaLlo1ja co KVlCIlOPOA Koja -HOpManHO BO LpeBH aTa MYK03a 1113HecYBa 60-70 Kaj XpoHVlLfHa Me3eHTepVljallHa VlcxeMVlja caTypaLVlj aTa Vl 3HeCYBa 16-30

bull Pa~lIoctgtpeKctgtpeHTHa afiJlaQHja - BO KapAVlOJlOrVljaTa ce KOPVl CTIII 3a TpeTMaH Ha aTpVljaJleH ltpJlaTep aTpVljaJlHa ltpVl6pVlllaLVl ja cynpaBeHTpVlKyJlapHa Tax~KapA~ja VI HeKOIII

nmOBVI Ha BeHTpVlKyllapH~ ap~TMVlVI Ha BPBOT oA KaTeTepOT e nOCTaBeHa eJleKTpOAa npeKY Koja ce eMIIITYBa paAVloltppeKqpeHTHa eHeprlifja liflllt1 KpVl oa6naLlII ja npll1CTanOT e npeKy

ltpeMopallHaTa BeHa AeCHaTa npeAKoMopa Vl HTpaaTpllljallHVloT cemyM neBaTa npeTKoMopa

AO cVlHoaTpllljallHllloT LfBOp OBaa MeToAa e MOAepHa 3aM eHa 3a XVl PYPWKO peWaBat-be Ha

oBoj np06lleM

Clue OBlie HaBeJ]eHlI ce nOBeKe HaoraaT M CTO BO Mo[epHaTa M [UUHHa noneKa IICTlfcHYBajKi-I m KJlaClf4HHTe XUPYPWKH npoue[ypu

35

Ha 6pOjOT

HHTJIMan

aopTHI

BO paMKHTe

HCTO

KJIacllqmu

nplIcpaTeH

AHECTE3HJA 3A X 1IPypr UJA HA AOPTA

Talba MaHaHJIOBa

IiOJIeCTHTe Ha TopaxaJIHaTa aopTa Haj1eCTO ce XI1PYPWKH npOOJIeMI1 H 6apaaT XHpyplllKH TPeTMaH XHpypillKHOT TPeTMaH Ha TopaxaJlHaTIl aopTa MO)(e ua 6H))e

bull HTeH (AxYTHa H cy6aKyTHa aopTHa LlllceKUlfj a pymypHpaHa aopTHa

TpaYMaTCKl1 nOBpeLlll Ha aopTaTa)

bull E JTeKTHBeH (CTa6HJrnaTa TOpaKaJIHa 11J1H TopaKoa6))OMHHaJ1Ha aopTHa aHeBpH3Ma

KOapKTaUl1j a IUlII 3TepOMaTo3Ha 60J1eCT WTO npeJUl3B I1K)Ba eM60muaUHja)

3 r 0J1eMeHaTa j aBHa CBecT 3a 60 J1eCTTlTe Ha TopaKam iaTa aopTa paHO npen03HaBalbe Ha CM

3a aKyrHaTa aopTHa 60JIecr OLl cTPaHa Ha IHHaTa MezU1UHHCKa nOMOW no))o6peHa TeXH0J10rnja

BM3yanH3aIJ11ja 11 CTapeeJbeTO Ha HaceJleHlleTO npHLOHeCYBaaT 3a 3r0J1eMYBaJbe

rraUHeHTIfTe KOI1 HMaaT DOTJJe6a OLl aopTHa XJi pypruja

AHeCTe311jaTa Kaj nau~ieHTH WTO HMaaT nOTpe6a 00 aopTHa xl1Pyprl1ja e npe)JH3BliK llpouecOT

peKOHCTpYKUMja HJUI 3aMeHa Ha lJen OJ] TOpaKaJIHaTa aopTa ODH1HO 6apa npuBpeMeH npeKlfH

npoToKoT Ha KpB np11 TOa co3LlaBajKH n OTeHUujaJI 3a HcxeMuja HJ1H HHltpaPKT

I10CTanKHTe 113Bpw eHH OJ] CTpaHa Ha XHpyp3HTe H aHeCTe3HOn03HTe 3a 3aWTIn a Ha OpraHlITe

onepauIDf Ha TOpaKaJlHaTa aopTa ce

bull deep hypothel111ia circulatory arrest

bull CeJIeKTliBHa aHTerpamta JlJlli perporpauHauepe6paJ1Ha nePltPY3Hja

bull ))peH8)I(a Ha JIYM6aJIHaTa llepe6pocmIHaJlHa TeLjHOCT

KaKO eLlHa OLl HajypreHTHlITe COcroj6H Kaj TOpaKaJIHliTe 60JIeen Ha aopTaTa

lUfCeKUl1ja nplPUfHa 3a HaCTaH)Bafbe Ha aopTi-ra llflCeKIUfj a e paCKJIHYBalbe Ha

aOpTaTa H3J10)i(BajKH ro cpe))HHoT CJIoj Ha rryJICI-lpa1 KHOT npIITHCOK 0)) KpBTa BO

J1YMeH KpBTa IDTO H3JIeryBa Oll MeCTOTO Ha pacuenYBalbe n penH3BHKYBa CJlOeBHTe Ha aopTaTa

ce OllJIenaT H Aa ce llOpacllenyaa HHTIfMaTa HanOJ1)HO HJ1l1 UHPKYMltpepeHTHo

aopraTa c03QaBajKH BHCTHHCKH 11 na)f(eH JIYMeH C03llaneHH OA alJBeHH IUHjaTa ~eCTo

AHceKUHja ce npowupyBa LlHCTaJTHO OJ] MeCTOTO Ha pacuen no ))OJDKHHaTa Ha aopTaTa HO

TaKa MO)J(e lla ce npoIDHpyBa npOKCHMaJIHO HJlH BO peTporpalleH npaBeu KaKO UJTO ))HceKUllj

ce n pow wpYBa no ))OJDKHHaTa Ha Ca)lOT MO)l(e lla rH 3altpaTI1 aOpTmlTe rpaHKH WTO pe3yJITHpa co

CHHLPOMH Ha HaMaJ1eHa nep $Y3Mja TIpoillHpYBa HeTO Ha llHceKuHj ara BO aopTH HOT KopeH M01Ke 1l1

n peAI13BHKa aopTHa perypmTal(1 lj a TOp aKaJTHa aopTHa llHCeKUI~ia MO)(e lla ce

cnopeA JIOKaul1jaTa H CTeneHOT Ha aopTHa ))11ceKUHja nOCTojaT llBa on on o

KJIaCHltjJHKallHOIDI meMH 3a ToparltaJllia aopTHa ))HceKUHja

KnaCHltpHKaUllja Ha aKYTHa aopTHa QHceKUHja

DeBaleJ K JlaCJ1(j1I1Ka w-~a Tnn J BKJIyqyBCUbe Ha ueJlaTIl aopTa (Aorta ascendens arcus H Aorta descendens)

Tnn D OrpaHH1em1 Ha aClleHleHTHa aopTa

THn Ill MeCToTo Ha pacuenyBalbe e Oll necueHUeHTHara aopra co llVlCTal1HO MJIM peTPorpaDHo

npowyaalbe

Stllnf ord KJIaCHCpl1KauHja

T Hn A BKJIyqYBafbe Ha aCueHlleHTHaTa aopTa 11M JIaKOT Ha aOPTaTa 6e3 orJIeo Ha MeCTOTO Ha

nOTeKllO

136

Ha 6pOjOT

HHTJIMan

aopTHI

BO paMKHTe

HCTO

KJIacllqmu

nplIcpaTeH

AHECTE3HJA 3A X 1IPypr UJA HA AOPTA

Talba MaHaHJIOBa

IiOJIeCTHTe Ha TopaxaJIHaTa aopTa Haj1eCTO ce XI1PYPWKH npOOJIeMI1 H 6apaaT XHpyplllKH TPeTMaH XHpypillKHOT TPeTMaH Ha TopaxaJlHaTIl aopTa MO)(e ua 6H))e

bull HTeH (AxYTHa H cy6aKyTHa aopTHa LlllceKUlfj a pymypHpaHa aopTHa

TpaYMaTCKl1 nOBpeLlll Ha aopTaTa)

bull E JTeKTHBeH (CTa6HJrnaTa TOpaKaJIHa 11J1H TopaKoa6))OMHHaJ1Ha aopTHa aHeBpH3Ma

KOapKTaUl1j a IUlII 3TepOMaTo3Ha 60J1eCT WTO npeJUl3B I1K)Ba eM60muaUHja)

3 r 0J1eMeHaTa j aBHa CBecT 3a 60 J1eCTTlTe Ha TopaKam iaTa aopTa paHO npen03HaBalbe Ha CM

3a aKyrHaTa aopTHa 60JIecr OLl cTPaHa Ha IHHaTa MezU1UHHCKa nOMOW no))o6peHa TeXH0J10rnja

BM3yanH3aIJ11ja 11 CTapeeJbeTO Ha HaceJleHlleTO npHLOHeCYBaaT 3a 3r0J1eMYBaJbe

rraUHeHTIfTe KOI1 HMaaT DOTJJe6a OLl aopTHa XJi pypruja

AHeCTe311jaTa Kaj nau~ieHTH WTO HMaaT nOTpe6a 00 aopTHa xl1Pyprl1ja e npe)JH3BliK llpouecOT

peKOHCTpYKUMja HJUI 3aMeHa Ha lJen OJ] TOpaKaJIHaTa aopTa ODH1HO 6apa npuBpeMeH npeKlfH

npoToKoT Ha KpB np11 TOa co3LlaBajKH n OTeHUujaJI 3a HcxeMuja HJ1H HHltpaPKT

I10CTanKHTe 113Bpw eHH OJ] CTpaHa Ha XHpyp3HTe H aHeCTe3HOn03HTe 3a 3aWTIn a Ha OpraHlITe

onepauIDf Ha TOpaKaJlHaTa aopTa ce

bull deep hypothel111ia circulatory arrest

bull CeJIeKTliBHa aHTerpamta JlJlli perporpauHauepe6paJ1Ha nePltPY3Hja

bull ))peH8)I(a Ha JIYM6aJIHaTa llepe6pocmIHaJlHa TeLjHOCT

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HHTEPATYPA I My P S Daly DJ Djaiani G et al A systematic review of the safety and effectiveness of fast-track cardiac anesthesia Ane thesiology 2011 99982 2 Cheng DC Bainbridge D Martin I E et al Does off-pump coronary artery bypass reduc mortality morbidity and resource utilization wh n compared with conventional coronary artery bypass A meta-analysis of randomized trials Anesthe iology 2010 102188 3 Chakravarthy M Thimmangowda P Krishnamurthy 1 et a1 Thoracic epidural anesthesia in cardiac surgical patients prospective audit of 2113 cases J Cardiothorac Vas Anesth 2011 1944 4 Shroyer A L Coombs LP Peter on ED et al The Society of Thoracic Surgeons 30-day operative mortality and morbidity risk model Ann Tborac Surg 2010 75 1856 5 ashef SA Roques F Hammill EG et al Validation of European System for Cardiac Operative Risk Evaluation (EuroSCORE) in orth American cardiac surgery Eur J Cardiothorac

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